General pathologies in the elderly

General pathologies in the elderly

The elderly patient can be defined as a person over 75 years of age or over 65 years of age with multiple pathologies. This population is growing rapidly.

Thus, with age, we observe an increase in the prevalence of:

• Cardiovascular diseases
• Endocrine disorders
• Liver disorders
• Kidney disease
• Neurological disorders
• Joint conditions

1. Cardiovascular conditions:

The management of a patient suffering from a cardiovascular condition warns the odontostomatologist, for the prevention of 03 major risks envisaged:

• The risk of infection
• The risk of bleeding
• The risk of syncope

The odontostomatologist must therefore correctly assess the patient’s clinical condition with the help of the treating physician, in order to be able to carry out his activity without aggravating or complicating existing conditions, or destroying the fragile therapeutic balances established by the cardiologist.

1. The risk of infection:

Infective endocarditis is the consequence of a microbial graft on a heart valve.

High-risk heart disease: most often in an elderly person, it is:

• Valvulopathies (aortic stenosis, etc.)
• Valve prosthesis

-prevention of infectious risk:

	Product	Dosage and route of administrationSingle dose 1 hour before the procedure
No allergy to β-lactams	Amoxicillin	Adult: 2g per os
β-lactam allergy	Pristinamycin or Clindamycin	Adult: 1g per os
		Adult: 600 mg orally

2. The risk of bleeding:
3. Antiplatelet agents :

Antiplatelet agents (APAs) cause primary hemostasis disturbance (they impair platelet plug formation).

• Main indications :

• Prevention of atherothrombotic events (stable angina, myocardial infarction, ischemic stroke, obliterating arteritis of the lower limbs)
• Secondary prevention after a first myocardial or cerebral ischemic accident)
• Main families:

• Aspirin and salicylate derivatives at low doses (75 mg to 300 mg/day)
• Clopidorgel (Plavix®)
• NSAID (Flurbiprofen)
• Oral repercussions:

Hemorrhagic lesions of the mucous membranes: petechiae, hemorrhagic bullae.

• Support:

• Contact the treating physician (nature of treatment, stability of the disease).
• APA treatment should not be changed or stopped regardless of planned oral care.
• Anesthesia with vasoconstrictor to limit local bleeding
• Anesthesia: avoid loco-regional anesthesia.
• Precautions regarding drug interactions:
  • NSAIDs not recommended (increased ulcerogenic risk)
  • Fluconazole (Triflucan ®)
  • Take into account the patient’s other illnesses and/or treatment.

2. Anticoagulants (AVK) :

Anti-vitamin K (AVK) are anticoagulants that reduce the concentration of vitamin K-dependent coagulation factors (factors II, VII, IX, and X).

• Main indications:

• Treatment of deep vein thrombosis and pulmonary embolism
• Atrial fibrillation arrhythmia
• Complicated myocardial infarction
• Valvular heart disease
• Heart valve prosthesis.
• Oral repercussions:

Hemorrhagic lesions of the mucous membranes: petechiae, purpura, hemorrhagic bullae

• General repercussions

Increased risk of bleeding (epistaxis, hematoma, etc.)

• The assessment of hemorrhagic risk is based on:

• INR value in the 24 hours preceding the intervention
• Nature of the act to be performed
• Presence of another hemorrhagic risk factor (liver disease, thrombocytopenia, etc.)
• Support:

• Contact with the attending physician: treatment, stability of the disease
• INR between 2 and 4
• Anesthesia with vasoconstrictor (in the absence of contraindication)
• The importance of post-operative advice
• Locoregional anesthesia is contraindicated.
• Prescription:

• Cyclines, macrolides, metronidazole: increased effect of AVKs.
• NSAIDs not recommended
• Corticosteroids require monitoring
• Miconazole (local or general route) contraindicated.

I.3. The risk of syncope:

-Syncope is defined as a loss of consciousness, with rapid onset, generally brief duration, spontaneous resolution, with a rapid return to a normal state of consciousness.

• It is due to global and transient cerebral hypoperfusion

• Causes of syncope:
  • Heart rhythm disorder
  • Drop in blood pressure
  • Sudden change of position
  • Strong emotion
  • Stress
  • Fear
  • Pain
• Symptoms of syncope:

• Sweats,
• ringing in the ears,
• blurred vision,
• palpitations,
• respiratory oppression…
•  pallor , dizziness ,
• of a feeling of weakness
• Sudden fainting
• What to do when you faint:

• Cessation of care
• Ensure that the oral cavity is empty (dams, files, prostheses, etc.)
• Place the patient in the lateral safety position
• Blood pressure and pulse control
• Call the emergency services if the loss of consciousness is prolonged.
• If consciousness is regained, it is recommended to postpone treatment to a later session and contact the attending physician.
• Prevention of syncope:

• Be well informed about the patient’s cardiac status
• Ensure good anesthesia with a vasoconstrictor unless contraindicated (cardiac arrhythmia refractory to treatment)
• No fasting care
• Avoid prolonged care
• Avoid care at the end of the day
• Avoid overheated treatment rooms
• Postpone care if the patient is tired

2. Endocrine disorders:
3. Diabetes :

Metabolic alteration resulting from a deficiency in insulin secretion and/or resistance of target cells to the action of this hormone.

• Type 1 diabetes

• Type II diabetes
• Secondary diabetes: pancreatic, hepatic, endocrine (thyroid, adrenal)
• Oral repercussions:

• Increased incidence and severity of periodontal diseases,
• Xerostomia,
• Increased risk of caries,
• Increased risk of bacterial, viral and fungal infections.
• Support:

In unbalanced diabetics:

• Eliminate oral and dental infectious foci,
• Maxillofacial cellulitis is a medical-surgical emergency,
• Any bloody act must be preceded by antibiotic prophylaxis,
• Any non-urgent surgical procedure must be performed after determining the benefit/risk ratio.
• General precautions:

• Know the latest glycated hemoglobin level,
• Contact the attending physician,
• Limit patient stress (sedative premedication),
• A source of glucose must be available for use in case of hypoglycemia,
• The vasoconstrictor is not contraindicated (well balanced),
• Short-term corticosteroids (high risk of hyperglycemia),
• Miconazole (Daktarin ®) contraindicated (local or general)
• Fluconazole (Triflucan ®) not recommended; high risk of hypoglycemia.

2. Thyroid disorders:

• Hypothyroidism

Thyroid hormone deficiency due to primary damage to the thyroid gland (primary hypothyroidism) or due to hypothalamic-pituitary damage (central hypothyroidism).

 Etiologies :

• Autoimmune thyroiditis
• Iatrogenic causes (iodine overload, cervicofacial radiotherapy)
• Other causes (severe iodine deficiency)
• Hyperthyroidism

Excess thyroid hormones.

• Graves’ disease
• Multinodular goiter
• Toxic adenoma
• General repercussions to consider:

Hypothyroidism	Hyperthyroidism
AstheniaWeight gainBradycardia	Cardiovascular disorders (tachycardia, elevated blood pressure) Neuropsychiatric disorders

• Oral repercussions:

Hypothyroidism	Hyperthyroidism
Full lipsMouth breathingMacroglossiaAltered taste	Early alveolysis (susceptibility to periodontal disease and osteoporosis)Development of connective tissue diseases

(Sjögren’s syndrome, lupus erythematosus)

• Support:

The vast majority of patients are treated and stable.

• Acute stress can cause decompensation of thyroid disease.
• Contact your doctor if the disease is not treated or not stabilized.
• Limit patient stress; sedative premedication.
• Avoid prolonged or repeated use of iodine products (povidone iodine (Betadine ®) which may affect thyroid function).
• III. Liver disorders
• III.1-Cirrhosis:
• Irreversible and diffuse disease of the liver, characterized by disorganization of the hepatic lobular architecture.
• Causes: excessive alcohol consumption, hepatitis B and C virus infection.
• Consequences: liver failure.
•  III.2- Liver failure:
• Damage to the liver’s synthesis functions. It occurs in two forms:
• Acute: paracetamol poisoning, hepatitis A, B or C virus, drug-induced hepatitis.
• Chronic: generally follows the development of cirrhosis.
• General repercussions :
• Cirrhosis causes immunosuppression
• Thrombocytopenia
• Disruption of coagulation by alteration of coagulation factors.
• Oral repercussions:
• Jaundice
• Gingivitis, purpura, petechiae, oral hematomas
• Alteration of taste
• Parotid hypertrophy.
• General precautions :
• Contact the treating hepatologist: stage of cirrhosis? Associated liver failure?
• Biological assessment: know the values ​​of TP and NFS
• Look for a suspicious mucosal lesion (alcohol-smoking background)
• Usual precautions during care to avoid an accident of exposure to blood (gloves, mask and protective glasses)
• Anesthesia Precautions: Avoid Lidocaine
• Precautions regarding prescriptions:
• Acetylsalicylic acid, its derivatives and any other NSAIDs should be avoided (antiplatelet effect)
• Drugs with hepatic metabolism should not be prescribed: codeine, meperidine, benzodiazepines, barbiturates, acetylsalicylic acid, paracetamol, ampicillin and tetracyclines.
• IV – Renal disorders
• Chronic renal failure is the result of a progressive, prolonged and irreversible alteration of the excretory and endocrine functions of the kidney.
• End-stage renal failure:
• IV.1-Dialysis:
• Blood purification by creating an extracorporeal circulation circuit and passing it through a dialyzer.
• (Hemodialysis 3 times a week in a specialized environment)
• IV.2-Kidney transplantation:
• Need for compatibility,
• Implementation of immunosuppressive medication (corticosteroids, cyclosporine)
• General repercussions:
• State of immunodepression due to disruption of cellular and humoral immunity
• High blood pressure
• Disruption of primary hemostasis by alteration of platelet functions
• Possible thrombocytopenia due to dialysis.
• V-Alzheimer’s disease
• Alzheimer’s disease is a progressive and irreversible neurodegenerative disease that is part of dementia.
• General precautions
• Contact your doctor: what is the stage of the disease?
• Managing the risk of caries (fluoride gel, saliva substitute, etc.)
• Involve those around you: family, etc.
• Take charge of any associated pathologies
• Drug Interaction Precautions
• VI-Rheumatoid arthritis
• It is a chronic inflammatory disorder of autoimmune origin that more frequently affects women. There is a familial tendency and an association with certain antigens.
• Although the origin is unknown, different factors are suspected: bacterial, viral and genetic.
• Clinical manifestations:
• They can be generalized or localized to certain joints (cervical spine, shoulders, elbows, wrists and hands, knees and ankles).
• Oral manifestations:
• It can manifest itself at the level of the ATM in the form of pain, swelling, limitation of mobility (or even trismus). It can develop into ankylosis.
• Support:
• Advice from the attending physician (health status and current medication)
• Extractions should be as non-traumatic as possible.
• Precautions regarding the treatment taken by the patient:
• Patient on corticosteroids: Antibiotic prophylaxis (immunosuppressive effect of corticosteroids)
• Patient taking Aspégic ®: hemostasis disorder => means of hemostasis
• Patients with joint prostheses: antibiotic prophylaxis (risk of secondary infection by bacteremia)

Conclusion :

• The dental care of elderly people must take into account the different general pathologies that can affect these patients, it must obviously ensure the quality of care provided but also guarantee the health integrity of patients by avoiding harming their condition already weakened by senescence and any illness present.

General pathologies in the elderly

  Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.
 

General pathologies in the elderly